Recommendations for selection of self-report pain intensity measures in children and adolescents: a systematic review and quality assessment of measurement properties

Pain, Physical, and Psychosocial Functioning in Adolescents at Risk for Developing Chronic Pain: A Longitudinal Case-Control Stusdy

This longitudinal case-control study aims to 1) compare symptoms and functioning in otherwise healthy adolescents with versus without a parent with chronic pain (Parent CP+/Parent CP-) 2) test adolescent sex as a moderator of the relation between parent CP group and child functioning, and 3) determine changes in adolescent pain over 1 year. Adolescents (n = 140; ages 11-15) completed tests of pain responsivity and physical function, as well as self-report measures assessing pain characteristics, somatic symptoms, and physical and psychosocial functioning. Self-reported pain and somatic symptoms were reassessed 1 year later. Adolescents in the Parent CP+ group reported greater pain, somatic symptoms, and worse physical health than Parent CP- youth. Parent CP+ youth performed worse on all tests of physical function. Some observed effects were stronger for girls than boys. There were no differences between groups on pain responsivity. Both groups reported increased pain and somatic symptoms from baseline to 1-year follow-up, with the Parent CP+ group reporting the highest level of symptoms at both time points. This study highlights the potential impact of parental pain status on children, particularly daughters, and is the first to document objective physical functioning differences in youth at risk for developing chronic pain. PERSPECTIVE: Adolescents who have a parent with chronic pain demonstrate higher pain and lower physical function than adolescents who have a parent without chronic pain. Group differences in pain and somatic symptoms persist over 1 year. Family based interventions are needed for comprehensive pain prevention and treatment.

The Feasibility and Effects of Acupuncture on Muscle Soreness and Sense of Well-being in an Adolescent Football Population

OBJECTIVE

The aims of the study were to assess the feasibility of performing acupuncture on multiple adolescent athletes in a warm weather, high-intensity training environment and to measure perceived effects of acupuncture on delayed-onset muscle soreness and sense of well-being.

DESIGN

This is a prospective feasibility study (registered clinical trial NCT03478800). Forty-two healthy male participants, aged 13-18 yrs, were involved in at least 1 of 5 treatment days for a total of 147 individual treatment sessions. Fifteen-minute treatments of traditional needle acupuncture were administered at the football field. Time, cost, adverse effects, and participant/provider ratio were observed. Effect on delayed-onset muscle soreness and sense of well-being were measured via pretreatment and posttreatment visual analog scale (0-10) rating analyses.

RESULTS

The results are as follows: time required by research staff on treatment days, 75 mins; total cost, US $700; temperature range, 21°C-28°C; and largest participant to acupuncturist ratio, 7-10:1. No major adverse effects occurred; 55% reported minimal adverse effects, such as mild focal numbness or tingling. Overall pretreatment to posttreatment effect on delayed-onset muscle soreness (average over 5 days) demonstrated significantly improved posttreatment scores (pre 4.6 ± 2.0; post 2.9 ± 2.2, P < 0.001). There was no significant effect on sense of well-being (P = 0.12).

CONCLUSIONS

Effectively providing acupuncture to multiple adolescent football players in their training environment is feasible with appropriate staff and resources. Despite mild adverse effects, treatment was well tolerated. This study provides guidance on acupuncture delivery to other athletes in their training environments.

Low-dose Oral Ketamine as a Procedural Analgesia in Pediatric Cancer Patients Undergoing Bone Marrow Aspirations at a Resource-limited Cancer Hospital in India

Aim:

Many pediatric cancer patients undergo repeated bone marrow aspirations (BMAs) for diagnostic and treatment evaluation purposes. Full anesthesia is the standard of care during this procedure in high-income countries. At hospitals with low resources in low/middle-income countries many children undergo these painful procedures without sufficient pain relief. This study aimed to evaluate the usefulness of low-dose oral ketamine as a procedural analgesic in a low-resource pediatric cancer care department.

Materials and Methods:

Pediatric patients, 4–15 years of age, who underwent BMAs between September 31 and November 30, 2018, were invited to participate. The study was designed as a placebo-controlled, single-blinded trial with three trial groups. Group K received 1.0 mg/kg of ketamine and Group KM received 1.0 mg/kg ketamine with an addition of 0.2 mg/kg midazolam, mixed in juice 30 min before procedures. Group P received placebo consisting of plain juice. All three groups also received the hospital's current standard treatment for procedural pain in BMAs. Patients and caregivers assessed the procedural pain, as did the performing doctors. For the patients, Faces Pain Scale – Revised was used and the Numeric Rating Scale-11 for caregivers and doctors.

Results:

A total of 87 patients were included in the study distributed with 29 in Group K, 29 in Group KM, and 29 in Group P. Seven patients were excluded, one patient denied participation and the remaining did not meet the inclusion criteria. There was no significant difference between the pain reported by the groups. A total of 69% patients in Group KM and 35% in Group K had somnolence reported as a side effect compared to 14% in Group P.

Conclusion:

We found no significant effects on the procedural pain in any of the treatment groups compared to placebo. There were only mild side effects. The doses of ketamine might be insufficient for this painful and stressful procedure.